Olga E. Makri

Drug-Induced Macular Edema

Macular edema constitutes a serious pathologic entity of ophthalmology resulting in vision loss with a remarkable impact on the quality of life of patients. It is the final common pathway of various systemic diseases and underlying intraocular conditions, with diabetes mellitus being the most frequent cause. Other causes include venous occlusive disease, intraocular surgery, and inflammatory conditions of the posterior segment of the eye. Macular edema is a recognized side effect of various systemic and local medications and requires special consideration among ophthalmologists and other clinicians. Recently, antidiabetic thiazolidinediones have been implicated in the development of macular edema, and a review of the English literature revealed that other systemically administered drugs like fingolimod, recently approved for relapsing forms of multiple sclerosis, the anticancer agents tamoxifen and the taxanes, as well as niacin and interferons have been reported to cause macular edema. Ophthalmologic pharmaceutical agents, like prostaglandin analogs, epinephrine, timolol, and ophthalmic preparation preservatives have also been reported to cause macular edema as an adverse event. The purpose of this article is to provide a short, balanced overview of the available evidence in this regard. The available data and the possible pathophysiologic mechanisms leading to the development of macular edema are discussed. Possible therapeutic strategies for drug-induced macular edema are also proposed.

Angiographically silent cystoid macular oedema secondary to paclitaxel therapy

Bilateral macular oedema is an uncommon side‐effect of paclitaxel administration in oncological patients. We report the case of a 64‐year‐old man who presented with decreased visual acuity due to bilateral macular oedema after paclitaxel administration for lung cancer. Optical coherence tomography scans of both eyes revealed cystoid macular oedema. Fluorescein angiography demonstrated the unusual finding of the absence of localised retinal capillary leakage. Ketorolac eye drops and acetazolamide tablets were prescribed and one month later the cystoid macular oedema resolved with subsequent improvement in visual acuity. This case illustrates the unusual presentation of cystoid macular oedema induced by paclitaxel.

Effect of a fixed brimonidine–timolol combination on intraocular pressure after phacoemulsification

PURPOSE: To evaluate the effect of a fixed combination of brimonidine–timolol on intraocular pressure (IOP) after phacoemulsification cataract surgery. SETTING: Department of Ophthalmology, Patras University Hospital, Patras, Greece. DESIGN: Prospective randomized comparative case series. METHODS: Patients scheduled for phacoemulsification were randomly assigned to 1 of 2 groups. The treatment group received 1 drop of brimonidine–timolol fixed combination immediately after surgery, and the control group received no treatment. The IOP was measured preoperatively and 6, 12, and 24 hours postoperatively. RESULTS: The treatment group comprised 28 eyes and the control group, 30 eyes. The mean IOP increased by 0.14 mm Hg ± 3.88 (SD) (P=.88) in the treatment group and increased by 2.8 ± 5.01 mm Hg (P=.007) in the control group. Twelve hours after surgery, the mean IOP decreased by −0.57 ± 3.82 mm Hg (P=.49) in the treatment group and increased by 2.20 ± 4.56 mm Hg (P=.009) in the control group. Twenty‐four hours after surgery, the mean IOP decreased by −1.57 ± 2.30 mm Hg (P=.012) in the treatment group and increased by 0.86 ± 4.21 mm Hg (P=.175) in the control group. The mean IOP change between the 2 study groups 6, 12, and 24 hours postoperatively was statistically significantly different (P=.015, P=.006, and P=.003; respectively). CONCLUSION: The fixed brimonidine–timolol combination effectively reduced IOP 6, 12, and 24 hours after phacoemulsification cataract surgery. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

A UPLC–MS Method for the Determination of Ofloxacin Concentrations in Aqueous Humor

A rapid, simple, and specific method based on ultra performance liquid chromatography (UPLC) with mass spectrometry detection has been developed for quantitative analysis of ofloxacin in human aqueous humor using tobramycin as internal standard (IS). Chromatographic separation was achieved on a Waters Acquity UPLC BEH C18 Shield column (150 × 2.1 mm, 1.7 μm) eluted with 95:5 water: acetonitrile (v/v) containing 0.1% formic acid and a flow rate of 0.3 mL/minute. The total analysis time was three minutes with ofloxacin eluting at 1.67 ± 0.03 minutes. The linearity of the method ranged from 0.1 to 8 μg/mL with r2 = 0.998. The method was validated according to FDA guidelines with respect to linearity, accuracy, precision, specificity, and stability. The limits of detection and quantification were 0.03 and 0.10 μg/mL, respectively. The developed method was successfully applied to the analysis of samples that have been obtained from patients.

Subconjunctival bevacizumab for corneal neovascularization secondary to topical anesthetic abuse

We report the clinical course of a 56-year-old patient diagnosed with toxic keratopathy due to topical anesthetic abuse. One month later, while a large corneal epithelial defect persisted, the cornea developed circumferential neovascularization that was treated with subconjunctival bevacizumab. Corneal neovascularization (CN) showed a dramatic regression 1 week after subconjunctival injection of bevacizumab. The epithelial defect slowly healed, no complications were observed, and no recurrence observed after 4 months of follow-up. In conclusion, bevacizumab may be valid complementary treatment in patients with CN secondary to topical anesthetic abuse. To our knowledge, this is the first case of CN due to topical anesthetic abuse benefiting from treatment of subconjunctival bevacizumab.

EFFECT OF BROMFENAC ON PAIN RELATED TO INTRAVITREAL INJECTIONS: A Randomized Crossover Study.

Purpose: To evaluate the analgesic effect of bromfenac, a topically administered nonsteroidal antiinflammatory agent, in patients undergoing intravitreal injections (IVIs) of anti–vascular endothelial growth factor agents. Methods: A single center, prospective, randomized, double-blind, placebo-controlled, cross over interventional study. Patients scheduled to undergo IVI of anti–vascular endothelial growth factor were randomized to receive topical bromfenac or placebo before IVI. Pain perception was assessed using the short form of the McGill Pain Questionnaire. Pain intensity was evaluated with the visual analog scale, the main component of the short form of the McGill Pain Questionnaire, and the Present Pain Intensity scores immediately and 6 hours postinjection. Results: Sixty-five patients (65 eyes) were enrolled in the study. Immediately after IVI, pain perception was statistically significant lower in patients treated with bromfenac compared with placebo as assessed by the visual analog scale pain score and the main component of the short form of the McGill Pain Questionnaire (P = 0.002 and 0.001, respectively). At 6 hours postIVI, pain was statistically significant lower in patients treated with bromfenac, according to the visual analog scale pain score, the main component of the short form of the McGill Pain Questionnaire, and the Present Pain Intensity score (P < 0.001, <0.001, and P = 0.001, respectively). Multivariable regression analysis revealed that pain perception, as evaluated with the visual analog scale pain score immediately after IVI, was significantly lower in patients of older age, female patients and those with higher number of previous injections. Immediately after IVI, bromfenac seemed to be more effective in younger patients and in those who had already undergone an amount of injections. Conclusion: Topical instillation of bromfenac significantly reduced the IVI-related pain immediately after and 6 hours postinjection.

Effect of Omega-3 Fatty Acids Dietary Supplementation on Ocular Surface and Tear Film in Diabetic Patients with Dry Eye

Objective: The objective of this study was to investigate the effect of dietary supplementation with omega-3 fatty acids on ocular surface and tear film in patients with type 2 diabetes suffering from dry eye. Methods: Thirty-six patients suffering from type 2 diabetes and moderate to severe dry eye syndrome were included in the study. Patients were assigned to receive omega-3 long-chain polyunsaturated fatty acids for 3 months. Tear film break-up time test, Schirmer-I test, and conjunctival impression cytology analysis were performed on all patients at baseline and after 1 and 3 months. The subjective symptoms of dry eye were evaluated with the Ocular Surface Disease Index (OSDI) questionnaire at the same time points. Results: Patients’ average age was 65.57 ± 4.27 years and the mean duration of diabetes was 14.85 ± 5.4 years. There was a statistically significant increase in Schirmer-I test results and tear break-up time score after 3 months of supplementary intake of omega-3 fatty acids compared to baseline (p < 0.05 and p < 0.001, respectively). Impression cytology demonstrated a significantly lower grade of conjunctival squamous cell metaplasia after 1 and 3 months of omega-3 fatty acids intake compared to baseline (p < 0.05 and p < 0.01, respectively). The OSDI score was statistically significant lower both at 1 and 3 months after omega-3 fatty acids supplementation compared to baseline (p < 0.001). Conclusions: Omega-3 fatty acids may effectively improve tear film characteristics, reverse ocular surface features, and alleviate the subjective symptoms associated with dry eye syndrome in patients with type 2 diabetes.

Brinzolamide-timolol fixed combination for the prevention of intraocular pressure elevation after phacoemulsification

To evaluate the efficacy of brinzolamide‐timolol fixed combination in intraocular pressure during the first 24 h after uneventful phacoemulsification cataract surgery using Viscoat and Provisc.

Diplopia due to systemic lupus erythematosus in a child: a rare clinical presenting sign of the disease.

We present the case of a 14-year-old girl who was admitted to the hospital with the complaint of horizontal diplopia for 48 hours. Initially, she was diagnosed with idiopathic intracranial hypertension. During hospitalization she developed fever, macular facial rash, and chest pain, and because of abnormal laboratory findings the diagnosis of systemic lupus erythematosus was established. She received immunomodulatory therapy, a combination of corticosteroids, and intravenous infusions of the monoclonal antibody rituximab, which augmented her clinical improvement. Intracranial hypertension secondary to systemic lupus erythematosus is a rare manifestation, especially as a presenting symptom. In addition, the fact that the patient developed an aggressive form of systemic lupus erythematosus during the initial period of hospitalization for idiopathic intracranial hypertension is also uncommon. Moreover, to our knowledge, we are not aware of any published case reports of intracranial hypertension secondary to systemic lupus erythematosus that was treated with rituximab.

Diclofenac for pain associated with intravitreal injections: a prospective, randomized, placebo-controlled study

Intravitreal injections (IVI) are often painful.